Healthcare Provider Details

I. General information

NPI: 1336235969
Provider Name (Legal Business Name): FATIMA ALIMATU FORNAH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FATIMA ALIMATU NJAI CRNA

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

3100 SPRING FOREST RD SUITE 130
RALEIGH NC
27616-2880
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-5645
  • Fax:
Mailing address:
  • Phone: 919-882-0706
  • Fax: 919-873-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number162501
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: